The Lancet Breastfeeding Series – and other January news

This January encapsulates what is good and bad in working to protect breastfeeding and to protect babies fed on formula – Baby Milk Action’s mission.

The Lancet’s latest breastfeeding series was launched at the end of the month, suggesting that the lives of 823,000 babies could be saved around the world every year through improved breastfeeding rates (this estimate is for 75 low-income and middle-income countries countries in the Countdown to 2015 data project).

Behind that statistic is a far higher number of babies who became sick with diarrhoea, respiratory and other diseases because of the greater risks associated with feeding on formula or other substances, rather than breastfeeding. Where there is access to health care, babies who are not breastfed are unlikely to die, but there is a cost to the health service.

“About half of all diarrhoea episodes and a third of respiratory infections would be avoided by breastfeeding. Protection against hospital admissions due to these disorders is even greater: breastfeeding could prevent 72% of admissions for diarrhoea and 57% of those for respiratory infections.”

And:

“Where infectious diseases are common causes of death, breastfeeding provides major protection, but even in high-income populations it lowers mortality from causes such as necrotising enterocolitis and sudden infant death syndrome.”

Many babies are, of course, being protected by breastfeeding already.

The authors also state: “we estimate that existing global rates of breastfeeding avert 19,464 annual breast cancer deaths compared with a scenario in which no women breastfed”.

The lives of a further 20,000 mothers could be saved with higher rates of breastfeeding, due to the lower incidence of breast cancer in women who breastfed.

This is why we work to protect breastfeeding from the aggressive marketing of the baby food industry. (Below, a promotion for infant formula in the UK – despite this being prohibited by law – claiming it provides “the healthiest nutrients”).

This marketing not only undermines breastfeeding, it misleads parents who use formula. A baby that is not breastfed and does not have access to expressed or donor breastmilk, should be fed on infant formula for the first year. Companies push unnecessary products beyond this with claims that we have proven to be false before regulatory bodies. (For example, the Advertising Standards Authority upheld Baby Milk Action’s complaints about the misleading promotion for Nestlé SMA toddler milk, shown right. These products are promoted as if they are needed to provide important nutrients).

All mothers need better protection and support, however they feed their children.

We also work to make breastmilk substitutes and baby foods safer for those parents who use them – and contributed to an important victory in this regard at the European Parliament this month (more on that later in part 2 of this blog post).

The UK comes out as the worst country in the Lancet study in terms of any breastfeeding to 12 months of age. Just 0.5% of babies, or 1 in 200, receive breastmilk at this age. By comparison, 27 per cent in the US, 35 per cent in Norway, 44 per cent in New Zealand and 92 per cent in India are breastfed until they are one year old (see the full list of countries in Table 4.2 in the Annex to the papers here – the image below is in the Lancet paper).

However, the headline that Britain is the worst, hides the good news. The vast majority of British babies are breastfed at birth (81% initiation, with 74% breastfed in the first hour, as recommended) and 34% at 6 months (though not exclusively, as recommended). Initiation rates have also been increasing over the past 20 years.

The Daily Mail in the UK suggests, “The study, led by experts from the World Health Organisation and Unicef, said that child obesity, diabetes and infections could all be significantly reduced if more mothers could be persuaded to breastfeed.”

This implies mothers are not wanting to breastfeed and need to be persuaded. I don’t think this comes from the Lancet series, which talks about “scaling up” breastfeeding, which requires a range of activities.

I have spent 20 years at Baby Milk Action working to protect all mothers and I think the suggestion that increasing breastfeeding rates is just a matter of persuasion misunderstands why so many mothers stop breastfeeding early.

“Of the mothers who had stopped breastfeeding by Stage 3 [8 to 10 months old], over three in five (63%) said that they would have liked to have breastfed for longer.”

We and other health campaigners are not aiming to force women to breastfeed. We would like the day to come when the vast majority of mothers can say they breastfed for as long as they wanted.

Mothers who decide to use formula need their right to accurate, independent information on products to be protected and for the products to be as safe as possible. Companies prove to be unreliable sources of information. First Steps Nutrition Trust, for example, produces independent reports on the different types and brands of formula, including analysis of company claims.

Unfortunately, we don’t know the current situation as the 2015 survey was cancelled by the government. The survey has been conducted every 5 years since 1975 and some would say the reason for cancelling it is the government does not wish the impact of its infant feeding policies to be measured and visible.

We can be clear that the rapid decline in breastfeeding is not due to lack of will that could be overcome simply by “persuasion”. The Infant Feeding Survey 2010 states:

“The most common reasons for stopping breastfeeding in the first week were problems with the baby rejecting the breast or not latching on properly (27%), having painful breasts or nipples (22%) and feeling that they had ‘insufficient milk’ (22%). The proportion of mothers citing ‘insufficient milk’ as a reason for stopping breastfeeding increased to a peak of 39% at six weeks to four months, then fell to 23% at six to nine months. This was also the most frequently mentioned reason for stopping breastfeeding overall.”

These are all issues that breastfeeding counsellors are trained to address and the surveys find that mothers who had support and had contact with friends who were breastfeeding were more likely to breastfeed for longer.

The goal of “scaling up breastfeeding” requires a range of strategies. “Promotion” of breastfeeding is part of this, of course, because it is important to explain that breastfeeding is more than nutrition.

In fact, the latest research in epigenetics, stem cells, and the developmental origins of health and disease is unlocking a whole new line of understanding of what breastmilk contains and its role in development. The authors of the Lancet paper cited here state:

“Human breastmilk is therefore not only a perfectly adapted nutritional supply for the infant, but probably the most specific personalised medicine that he or she is likely to receive, given at a time when gene expression is being fine-tuned for life. This is an opportunity for health imprinting that should not be missed.”

However, a Department of Health survey in England in 2005 found that a third of mothers believe that formula is the same or almost the same as breastfeeding. This is wrong. One of the Lancet study authors states:

“There is a widespread misconception that the benefits of breastfeeding only relate to poor countries. Nothing could be further from the truth.”

UNICEF has calculated that the National Health Service could save £40 million per year if breastfeeding rates increased moderately in the UK, because tens of thousands fewer sick babies would be admitted to hospital. Actual savings would be greater as UNICEF was looking at just five illnesses. There are theoretically far greater economic benefits due to the better health and development outcomes for breastfed babies in the longer term.

Formula provides nutrition, but it is not a living substance like breastmilk, adapting to the baby’s stage of development, providing protection against infections to which mother and baby are exposed, and contributing to development in ways that are still not understood.

Formula companies state their products are based on breastfeeding research, implying they replicate breastmilk. Another significant development this month shows just how untrue this is.

Nestlé being Nestlé, it made no apology for suggesting its old product was comparable to breastmilk.

It repeats the same strategy, making the announcement part of a launch of its “new, improved” formula, boasting this has a “protein profile closer to breastmilk” (left).

It has been using the same strategy for 150 years – January also marks the foundation of the company, when Henri Nestlé started marketing farine lactée. Now recognised as totally unsuitable for newborns, Henri Nestlé was soon exporting it to developing countries, starting the assault on breastfeeding cultures.

It is perhaps surprising that many health workers may have had little training on infant feeding. The Lancet study authors comment, “The fact that the reproductive cycle includes breastfeeding and pregnancy has been largely neglected by medical practice, leading to the assumption that breastmilk can be replaced with artificial products without detrimental consequences.”

Companies such as Nestlé actively promote this idea, following their statements of support for breastfeeding with idealising claims for products, as in the above example. Nestlé employs Clinical Representatives with the stated responsibility of targeting health workers to achieve brand endorsements for its formula brand.

In the UK, we coordinate a project monitoring the baby food industry on behalf of the Baby Feeding Law Group, a coalition of leading health professional and mother support organisations. Nestlé is not alone in aggressively marketing baby foods and targeting health workers to encourage them to endorse company products. I write more about this in part two of this blog post.

We know what is necessary to reverse the decline in breastfeeding. It is set out in the Global Strategy for Infant and Young Child Feeding, which the UK has supported repeatedly at the World Health Assembly.

The Global Strategy covers the full range of initiatives that are needed.

The International Baby Food Action Network (IBFAN) developed a tool to assess how well countries are doing: the World Breastfeeding Trends initiative (WBTi). Baby Milk Action is the UK member of IBFAN. Visit the website to see if your country has been assessed.

A new All Party Parliamentary Group (APPG) on Infant Feeding and Inequalities was formed at the UK Parliament in January to discuss what needs to be done. Baby Milk Action and a wide range of health professional and mother support groups attended the preliminary meeting organised by Alison Thewliss MP last November, where there was a presentation of preliminary findings by the WBTi working group coordinators.

We asked our supporters to contact their Members of Parliament to attend a meeting to formally set up the APPG in January as it needs cross-party support. Thank you to everyone who did so, because there was a good turnout and the APPG has now been formed and is getting to work.

Hopefully the APPG will help the government implement the aspects of the Global Strategy where there are found to be gaps and encourage it to reinstate the National Infant Feeding Survey so the impact of policies can be measured and available publicly.

Then we might see a reduction in the number of mothers who say they wanted to breastfeed for longer.

In the second part of this blog post I look at some of the other papers in the Lancet Breastfeeding Series, with more of a focus on the role of the formula industry in undermining breastfeeding, misleading parents who use formula and sabotaging health policies to protect their own financial interests.

The Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect paper is free to access if you want to go to the source of the above quotes – it took me 40 minutes to read (not including the annexes). The authors, “obtained information about the associations between breastfeeding and outcomes in children or mothers from 28 systematic reviews and meta-analyses, of which 22 were commissioned for this review”.

7 thoughts on “The Lancet Breastfeeding Series – and other January news”

Thanks Mike, you are absolutely right, all of us heard about the new Lancet series, read the press-releases, were happy with the good news (that advantages we all knew all along had now -again- become “official”) and then we went on with our daily lives without reading the full Lancet reports. Your blog stimulated me to read them now.
I do hope that your Part II has a reference to our latest app. IBFAN-ICDC has launched this device to make monitoring fast and easy. The app can be downloaded on smartphones so that when you do see a Code violation, you can take a picture and denounce the company instantly directly from yr phone to our Centre so it will get published. Breastfeeding needs to be protected from the greedy manufacturers who sell substitutes such as formula, cereals, juices and teas and make moms feel they need such commercial products for their babies. Such ads and glamorous promotion undermines breastfeeding more than anything else. Health workers don’t have the millions to aggressively promote breastfeeding but they do have the International Code that prohibits marketing tactics for substitutes. Let’s shame these companies.

Thanks a lot Mike, the new Lancet series, read the press-releases,are very interresting and important to all of us, and i am happy with the good news
regarding a Code violation, i took some a pictures and i will send it to you most of the pharmacies in libya are violating the code because ofpolitial instability . and i am with my collegue (Annelies Allain) who says ” Breastfeeding needs to be protected from the greedy manufacturers who sell substitutes such as formula, cereals, juices and teas and make moms feel they need such commercial products for their babies. Such ads and glamorous promotion undermines breastfeeding more than anything else. Health workers don’t have the millions to aggressively promote breastfeeding but they do have the International Code that prohibits marketing tactics for substitutes. Let’s shame these companies”. my regard

Its well covered summary. Hope this will be important additional tool for advocacy. But what current Lancet series says has already been used except statistics regarding mothers mortality. That means apart from this we need to improve knowledge and practices of health workers and health facilities. Deployment of IYCF counsellors from community to facility will go strong for support and encouragement. Its true that most mothers will initiate, continue and sustain breastfeeding if helped at their need. But still there are mothers with small,flat,retracted or unusually large nipples and babies with organic or functional inability to feed where counsellor may not succeed. Few mothers I find they think breastfeeding as animal like behaviour and they fail to realize we all are also living beings like animals. We need to address such difficult issues also.

Thanks a lot Mike, the new Lancet series,
its really eye opener for the policy makers. its time to come out with strong code against formula feeds .Breastfeeding needs to be protected from the greedy manufacturers who sell substitutes such as formula, cereals, juices and teas and make moms feel they need such commercial products for their babies. needs lots of awareness among people regarding breast feeding practices .
Thanks for the series on breast feeding in Lancet